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So far this year, 50 people had died in Pennsylvania from Fentanyl-related overdoses. Fentanyl is a prescription drug. It's an opiate, more powerful than morphine. It's often used to treat cancer patients in extreme pain. An illegal non-prescription version of Fentanyl led to hundreds of deaths in Pennsylvania in 2006. And state health and drug enforcement officials are now worried it's on the rise again. From the HERE AND NOW Contributor's Network, WHYY's Elana Gordon reports.

ELANA GORDON, BYLINE: Lebanon County in South Central Pennsylvania is a small, tight-knit kind of community. The county's drug and alcohol abuse services coordinator, Carol Davies, says when something out of the ordinary occurs, it doesn't take long for word to get out. That happened in late spring when within a seven-hour period, she got calls about four overdoses. The medical interventions that usually bring someone back from a suspected heroin overdose didn't work. One person died.

CAROL DAVIES: Well, we were thinking it was really kind of scary because they could tell they were dealing with a different substance.

GORDON: Tests confirmed it was Fentanyl, a powerful prescription painkiller. So Davies contacted state officials to see if this was a problem elsewhere. Within weeks, they'd identified Fentanyl-linked overdose deaths in more than a dozen other Pennsylvania counties. The state issued a public health alert. One death was in Philadelphia. Roland Lamb, who heads the city's addiction services, is worried. He says when produced illicitly, Fentanyl can look like heroin, white and powdery, but it's much stronger.

ROLAND LAMB: That poses, you know, significant problems in terms of overdose because they're naive to that drug, with the potency of that drug, which can be anywhere from the pharmaceutical, which is four to, you know, eight times more potent than the heroin in the streets to the illicitly produced, which is 40 times more potent.

GORDON: Lamb remembers when Fentanyl got mixed into Philly's heroin supply in 2006; it's still hard for him to talk about. Fentanyl-linked drug overdoses killed nearly 300 people in Philadelphia that year. Nidia Flores was almost one of them.

NIDIA FLORES: I've OD'd in between the two cars over there.

GORDON: I met Flores in the Philadelphia neighborhood where she used to do heroin. She points to the spot where she overdosed in the snow on a winter morning in 2006. Flores says she thought she was taking pure heroin, but it was laced with Fentanyl. Luckily, she wasn't alone. A friend called 911.

FLORES: They told me that if they were to not got there in two more minutes, I would have died.

GORDON: Flores was OK. Some others she knew start out what they thought was a more intense high that Fentanyl offered. The drug was so potent, people were OD'ing with needles still in their arms.

FLORES: I know, like, maybe five women that died off of that. So many women died. So many women died because they didn't know what's in it.

GORDON: Flores still lives in the neighborhood but now spends her time reaching out to people, connecting them with services. Drug enforcement and public health officials, meanwhile, are still trying to make sense of what happened in 2006 and hope to prevent it from happening again.

Jeremiah Daley is director of HIDTA or the Philadelphia-Camden High Intensity Drug Trafficking Areas. Inside his secured office, maps on the wall trace identified drug distribution routes and sources throughout the continent. Daley says he got a call this spring, notifying him of Fentanyl overdoses.

JEREMIAH DALEY: It was kind of the oh-crap moment.

GORDON: Daley says he's not sure why Fentanyl became such a problem in 2006, but he has some theories. Fentanyl is not easy to make, and drug enforcement officers track much of the Fentanyl to one production plant in Mexico. Daley thinks heroin producers were experimenting, mixing Fentanyl with heroin to try and make a more profitable drug that can make them more money. Daley wonders if someone's experimenting again.

DALEY: Generally speaking, a drug dealer doesn't want to put something in there, you know, that's, you know, fatal to somebody because that's a customer that they lose. At the same time, they do try to create new experiences, I guess, for their users that would be more pleasing to them, to draw them back to buy more. And we think - and this is only a theory at this point - we think that that's what's happening now with the Fentanyl, is that some distributors have been adulterating their heroin with Fentanyl to create a more enhanced high.

GORDON: Daley says it's too soon to say whether Fentanyl is making a comeback in Philadelphia. The drug has been linked for 14 overdose deaths in Rhode Island and is suspected in the deaths of five people in Massachusetts. The Centers for Disease Control has issued a nationwide health alert. For HERE AND NOW, I'm Elana Gordon in Philadelphia. Transcript provided by NPR, Copyright NPR.